The differential diagnosis on the electrocardiogram between ventricular tachycardia and preexcited tachycardia
Open accessAbstract
The 12-lead surface electrocardiogram is a simple and useful tool for the differential diagnosis of regular wide QRS complex tachycardia. However, criteria do not as yet exist to discriminate between ventricular tachycardia and supraventricular tachycardia with anterograde conduction over an accessory pathway (preexcited tachycardia). Therefore, we designed a new stepwise approach with three criteria for the electrocardiographic differential diagnosis between ventricular tachycardia and preexcited tachycardia and prospectively studied 267 regular tachycardias with electrophysiologically proven mechanism and a wide QRS complex (> or = 0.12 s): 149 consecutive ventricular tachycardias and 118 consecutive preexcited regular tachycardias. Underlying heart disease was old myocardial infarction in 133 of 149 (89%) ventricular tachycardias. The patients presenting with preexcited tachycardia had no additional structural heart disease. Atrial fibrillation with preexcited QRS complex was not included. The criteria favoring ventricular tachycardia were: (1) presence of predominantly negative QRS complexes in the precordial leads V4 to V6, (2) presence of a QR complex in one or more of the precordial leads V2 to V6, and (3) AV relation different from 1:1 (more QRS complexes than P waves). The final sensitivity and specificity of these three consecutive steps to diagnose ventricular tachycardia were 0.75 and 1.00, respectively. This new stepwise approach is sensitive and highly specific for the differential diagnosis between ventricular tachycardia in coronary artery disease and preexcited regular tachycardia.
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This algorithm has not been validated in other studies.
“but this algorithm has not been validated in other studies.”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [63]
There has been one report on the analysis of 267 wide-QRS tachycardias, consisting of VT and antidromic AVRT; the derived criteria were found to offer sensitivity of 75% and specificity of 100%.
“There has been one report on the analysis of 267 wide-QRS tachycardias, consisting of VT and antidromic AVRT.The derived criteria were found to offer sensitivity of 75% and specificity of 100%, 63”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [63]
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- Authors
- Steurer, G., Gürsoy, S., Frey, B., Simonis, F., Andries, E., Brugada, P., & Kuck, K.
- Affiliations
- Onze Lieve Vrouwziekenhuis Hospital (BE)
- Corresponding author
- Brugada, Pedro
- Venue
- Clinical Cardiology
- Publisher
- Wiley
- Published
- 1994-06
- Volume
- 17
- Issue
- 6
- Pages
- 306-308
- ISSN
- 0160-9289 (ISSN-L)
- 1932-8737
- OpenAlex
- W1980106498
- Cited by
- 53
- References
- 6
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 3 · 2020: 5 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 3 · 2015: 1 · 2014: 2 · 2013: 1 · 2012: 1
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Austrian Science Fund
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- ventricular tachycardia, wide QRS tachycardia, accessory pathway, coronary artery disease, myocardial infarction
- MeSH terms
- Coronary Disease, Diagnosis, Differential, Electrocardiography, Humans, Pre-Excitation Syndromes, Prospective Studies, Sensitivity and Specificity, Tachycardia, Ventricular
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